Comparative study of pharmacokinetics, pharmacodynamics and cost-effectiveness between first-line Angiotensin Converting Enzyme inhibitors in Saudi Arabia during 2023

Angiotensin-converting enzyme (ACE) inhibitors were discovered in 1980 and since then they are used in many conditions like stable chronic heart failure, myocardial infarction (MI) and diabetic nephropathy and developed to become a recommended first-line therapy for hypertension (HTN), yet very few comparative studies and head-to-head trials exist to date. Hence, this study aimed to clarify ACE inhibitors pharmacokinetics and pharmacodynamics differences, assess the cost-effectiveness of ACE inhibitors, elaborate safety and side effects of ACE inhibitors, discuss which ACE inhibitor is favorable for variety of cases, and to promote more comparison studies and head-to-head trials between ACE inhibitors. This review article used published studies of ACE inhibitors properties and extracted data from Saudi Food and Drug Administration. It was found that enalapril has the longest duration of action of all ACE inhibitors, lasting 35 to 38 hours. While perindopril has the highest bioavailability, 65-75%, compared to other ACE inhibitors. The price variance of ACE inhibitors was found as lisinopril with the lowest price (18.7–37.45 Saudi Riyals SAR) and zofenopril with the highest price ($192). Further, zofenopril, trandolapril, and quinapril are the medications that are unavailable in Saudi Arabia. Moreover, angioedema is one of the most dangerous side effects of ACE inhibitors, along with hyperkalemia, kidney issues, headaches, and cough. However, the side effects of all these drugs are similar. Hence, it was concluded that the future of ACE inhibitors might also involve improved safety profiles through the development of novel ACE inhibitors with fewer side effects or better tolerability.